| NPI | 1083906358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005530) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2012-11-30 |